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ANUS – What can it show us…..?

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ANUS – What can it show us…..?

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  1. ANUS – What can it show us…..? Chris Driver RACH

  2. Definition… • >4mm @ any stage of gestation? • >5mm @ any stage of gestation? • >7mm @ 30 weeks? • >10mm……?

  3. Diagnoses….. normal – 90% VUR NONRMU VUJ obstruction posterior urethral valves MCD kidney duplication anomalies PUJ obstruction …….!

  4. ANUS

  5. Post natal ultrasound (PNUS)

  6. PNUS • Day 0 • underestimates c/w ANUS • early management of severe abnormality • 6 week • definitive scan • will be “worse” than day 0

  7. VUR • “dilating” reflux only • more likely to get better c/w PNDx • Plan: • Antibiotic prophylaxis • MCUG • DMSA

  8. Hyroureteronephrosis • VUR • VUJ obstruction • Non obstructing non refluxing megaureter • Plan • MCUG • MAG3 (age >3 months) • Antibiotic prophylaxis (until VUR excluded)

  9. NONRMU vs VUJ ….? • exclusion essentially • cytsocopy and retrograde – “rats tail” • clues: • increasing HUN • reduced function

  10. NONRMU vs VUJ ….? • Plan: • observe • JJ stent insertion • diagnostic +/- therapeutic • TUU • reimplant

  11. Posterior Urethral Valves • bladder outflow obstruction • unilateral (good) or bilateral (bad) HUN • oligohydramnios (bad)

  12. Posterior Urethral Valves • Plan: • MCUG +/- catheter • bloods • optimised fluid management • antibiotic prophylaxis • valve resection +/- vesicostomy

  13. Multicystic dysplastic kidney (MCDK) • failure of fusion of ureteric bud and developing kidney • 0% Function on DMSA • risks minimal

  14. Multicystic dysplastic kidney (MCDK) • Plan • PNUS • DMSA • Default is non-operative

  15. PUJ “obstruction” dilatation ¹ obstruction isolated hydronephrosis aetiology intrinsic extrinsic

  16. PUJ “obstruction” • Plan: • PNUS • MAG3 ->3 months • no need for prophylaxis

  17. Options? • observe • serial USS • occasional renogram • DMSA more accurate for function • operate

  18. kidney ureter renal pelvis Dilated pelvis Tortuous ureter

  19. ANUS and PUJO – Is size important? • GOSH data on PNUS • >35mm comes to surgery eventually • when can we leave alone? • unclear • <10 mm – surgery rare • <19mm – 5% come to surgery (unpublished) • but ……around 3% deteriorate over time • usually 1st 2 years

  20. ANUS advantages permits early detection of renal pathology ?intervening early improves overall outcome? disadvantages no evidence base for criteria for intervention no consensus for early discharge increased parental anxiety

  21. Any Questions….?